Scar Management Before & After Case 265

This patient in her late 60s came to see me for facial rejuvenation just two years after having a facelift with a different surgeon. She was particularly bothered by new “wrinkles” over her left cheek which she noticed shortly after her initial surgery. She is pictured four months after I performed a secondary/revision facelift, facial fat grafting, buccal fat removal and erbium laser resurfacing. Her story illustrates two important points about facial rejuvenation. 
The first, is the correction of a “lateral sweep”. A lateral sweep is a problem that occurs after a facelift where there is an inappropriate direction of pull and amount of tension placed on the skin and underlying foundation of the face. The result of the imbalance is that the loose portion of the upper face sags over the tighter lower face, creating the unnatural transverse wrinkles pictured. This was corrected with a secondary facelift to optimize the position and tension on the skin and underlying foundation.
The second point is that facial aging is multifactorial and involves laxity of the underlying foundation, loss of facial volume, and degeneration of the skin. A facelift helps to address laxity of the foundation, but more must be done to address the other two processes. For this patient I performed erbium laser resurfacing to improve the quality of her skin and address some of her fine lines, as well as facial fat grafting to correct the volume loss that had occurred over time. Incidentally, I also performed buccal fat removal to improve the contour of her face.